SWW3923
Semantic Web Sparks Evolution of Health 2.0 –
A Road Map to Consumer-Centric Healthcare
Jen McCabe Gorman and Maarten den Braber
Abstract — Delivery strategy in a consumer-centric
healthcare system focuses on identifying, facilitating, and
integrating online and offline communication and care
delivery channels needed to reach and coordinate end
goals (value) as defined by disparate customer segments
(patient, provider, payor, policymaker, caretaker,
etcetera).
Services are location independent, time independent,
provider de-linked, and value-generating. Rising
healthcare costs, increasing chronic conditions, and
barriers to access drive the search for a new route to safer,
cost-effective quality care.
Health 2.0 is content and community: patients trusting
patients. The semantic web sparks Health 2.0 evolution
towards more consumer-centric care by enabling viral
network growth and increasing personal-usage value of
patient-created, "human-to-human" centric networks.
Semantic web technology and open source API
development provide opportunities to build consumer-
centric services. But the roadmap for true consumer-
centric care does not end with semantic web growth –
rather it begins there.
The authors present a conceptual roadmap for reaching
consumer-centric care at the intersection of two rapidly-
evolving developmental axes: joining patients and
professionals in the healthcare conversation and
combining brick-and-mortar real world systems with
virtual online services. Future evolutionary phases Health
3.0 and 4.0 are defined using examples.
The authors provide a model, termed "neXthealth,"
which gives stakeholders concrete tools to define their
position (using existing service lines and development
initiatives) and focus on four critical factors needed to
realize complete consumer-centric care: content,
community, commerce and coherence.
Jen McCabe Gorman (jennifermccabegorman@yahoo.com) and Maarten den
Braber (mdb@twister.cx). In collaboration with Martijn Hulst, Jacqueline
Fackeldey, and Niels Schuddeboom, the authors arranged the first
international Health 2.0 Unconference, held April 12, 2008 in Amsterdam
(http://www.health20.nl/). These efforts led to the creation of the neXthealth
movement. The group is currently evangelizing the use of Health 2.0
initiatives in Dutch and European healthcare systems, organizing a series of
unconference sessions for hospital teams and the inaugural neXthealth Europe
meeting (Spring 2009).
Index Terms — consumer-centric care, health 2.0, health
3.0, health 4.0, neXthealth, semantic web, healthcare
consumerism
I. INTRODUCTION
The power and role of the internet for patients, and for also
caregivers, medical professionals and other stakeholders in
health, is increasing: the era of the e-patient, e-doctor and e-
medicine dawns . But while patients are increasingly
communicating and collaborating with ‘likes’ (other patients),
barriers to seamless, productive online and offline
communications with ‘non-likes’ (providers, payors) persist.
Early web-based healthcare activities were limited to
providing information (provider side) and searching for
information (consumer side). Health 1.0 was all about content
- medical dictionaries, hospital websites and finding
information on new or obscure treatments. But patients lacked
a relevant way to form meaningful connections around
information obtained online.
The advent of Health 2.0 – content combined with
communities – provides a way for patients to establish online
relationships oriented around the achievement of personal
health and wellness goals.
However, current virtual services still do not allow patients
to transport the full value of these communities back offline –
they do not completely integrate ‘traditional’ brick-and-mortar
healthcare providers and care processes with online services.
As Health 2.0 evolves, two important changes will take
place. First, a cultural change – revising the traditional,
exclusionary definition of who participates in healthcare and
wellness management conversations (to include patients as
integral partners in care and prevention). Second, a technical
or business model change - which involves joining online
services targeting patients with existing offline services,
providing seamless semantic interoperability [2], emphasizing
the importance of consumer engagement and patient
responsibility.
Health 2.0 is one stop on the roadmap towards true
consumer-centric care, but it is not our final destination. The
next stop on the roadmap, Health 3.0, harnesses the value of
communities through value-based interactions. Health 4.0 is
the stage that connects all earlier phases.
Although semantic web development sparks the evolution
of consumer-centric care, we define it not as the end-stage but
rather the route that leverages new ways of communicating
and collaborating. Complete consumer-centric care (C4)
consists of four important C’s: content, community, commerce
and coherence. The ultimate goal of the consumer-centric
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movement is the 5th and final ‘C’ – care that is more efficient
and empathic.
II. EVOLUTIONARY STAGES OF CONSUMER-CENTRIC CARE
Health 1.0 (1C) = content, the “read-only” Web. Examples
are WebMD, early DrKoop e-newsletters, and searching for
clinical information on MedScape.com.
Health 2.0 (2Cs) = content + community. Health 2.0 adds
community on top of new and existing content. Health 2.0
services provide ways for patients to collaborate using
information accessed online: patients start trusting patients.
An example of a Health 2.0 service is DiabetesMine.com, run
by blogger Amy Tenderich [3].
Health 3.0 (3Cs) = content + community+ commerce.
Health 3.0 is Health 2.0 plus the addition of commerce, which
involves firms building business models based on consumers
accessing content and forming groups. Commerce is the
portion of Health 3.0 that successfully adds value. Value is
defined by four important characteristics: (1) spans the
complete process, (2) always connects to a specific
stakeholder (3) differs for every individual stakeholder, (4)
must be delivered through a sustainable process [4].
Commerce is the function that adds value for both the
consumer and the clinician. It is important to note here that
‘commerce’ in a consumer-centric system can be defined as
any transaction-based model, not necessarily one that is
monetized. The commerce requirement of Health 3.0 can be
satisfied simply, with the consumer sending information/data
to the service, ‘transacting’ with the system via transmission
of personal identifying information – for example, by
establishing a user account and logging in repeatedly to a
website.
Indeed, many Health 2.0 companies are built upon 'free' or
'freemium' access models. In a 'freemium' model, basic
interaction with a site is free, but users are charged for a
premium membership, which provides additional value-added
services (e.g. SugarStats.com).
Examples of current Health 3.0 companies are American
Well, Carol.com and Organized Wisdom. In some Health 3.0
models, like searching for a condition-based WisdomCard ™
on Organized Wisdom, consumers transact with the system by
interacting using personal identification data (user login, etc).
This method of commerce, the 3rd C of Health 3.0,
maximizes value for both parties - the consumer gains a
WisdomCard compiled by a Health Guide utilizing semantic
web techniques ("smart search" or “human powered search”),
while the company gains additional user data and
demomodelics that inform future search topics. This user
interaction is precisely what creates value, literally ‘organizing
wisdom’ via an informed user base. In the Health 3.0 sphere,
simply gaining a new user increases value for companies, as
user-strength/community-strength numbers often drive market
valuations and are a primary data set used to secure advertisers
and venture capital.
At an industry-wide level, with the onset of the Health 3.0
phase entrepreneurs will test business models that move
beyond traditional ad-revenue based income streams. Health
3.0 will be heralded by an era of mergers and acquisitions:
small, inefficient, redundant offerings die out, some
organizations will merge with larger firms, and additional
partnerships will develop among Health 2.0 startups.
Health 4.0 (4Cs) = content + community + commerce +
coherence. This evolutionary stage connects the real world of
brick-and-mortar systems with the virtual world of online
services.
Coherence features in Health 4.0 companies will connect
patients and professionals in new ways: facilitating human-to-
human conversations that determine care pathways both on
and offline. Health literacy developed in earlier stages is
employed here – patients become an integral part of the
healthcare conversation, proactive partners in care responsible
for setting and working towards personal wellness goals.
At the Health 4.0 stage we begin to move beyond a flawed
encapsulation approach to treating illness and injury, which
has resulted in today’s perpetually fragmented delivery
system. At the Health 4.0 stage we see an emphasis placed on
optimizing health and wellness, prior to a disease state, all
along a consumer’s lifeline.
Health 4.0 will begin to emerge when multiple stakeholder
groups realize the system lacks coherence necessary to evolve.
Businesses, hospital systems, NGOs, governmental agencies,
consumers, nonprofits, foundations, providers, caregivers,
pundits, academics et. al. begin to agree that although many
offerings provide access to content and community, as well as
to the most advanced medical technologies, there remains a
catastrophic gulf. New coalitions and partnerships will
acknowledge the value of cooperative work groups in building
a bridge to better care.
As a result, interactions between consumers at the
intersection of the “real/virtual” axis and the
“patient/professional” axis, as the authors will illustrate using
the ‘neXthealth model’, become much more coherent. Real-
time, seamless interoperability is achieved as companies join
forces. Here we present a scenario that incorporates multiple
stakeholder interactions and illustrates what is possible with
the advent of Health 4.0.
III. AN EXAMPLE OF HEALTH 4.0
A consumer is out shopping and begins having difficulty
breathing – but the problem is not so severe that she
immediately seeks emergency care. The patient logs onto a
web browser from the store, using her BlackBerry. This is a
new symptom onset.
She accesses a chat with a doctor function, which includes
live streaming video, via the American Well system.
American Well is an existing Health 3.0 firm which allows
users to access online physician services. Access is paid for by
the consumer’s insurance provider.
This first portion of our scenario is not far off in the future –
a physician-chat function will actually be available using the
American Well software as a service (SaaS) platform later this
year. However, American Well is currently only enabling live
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video via a computer access point, not a mobile phone access
point. Scientists are, however, working on telemedicine
capabilities for mobile phones [5].
Back to our patient, who is concerned about her respiratory
issue. The physician chatting with her through the American
Well portal also becomes concerned, and begins
simultaneously transmitting a transcript of the call to the
patient’s local emergency room. Such a service is not yet
available, but when it emerges, provides the coherence
necessary to connect the 4Cs of complete consumer centric
care.
This case scenario allows our consumer to access expert
content via a community portal (American Well’s SaaS
service which connects consumers to providers in real-time),
and fulfills the 3rd C, commerce, via a value-added transaction
where she gains the physician’s recommendation, virtually,
that she should visit her local emergency room, where the
physician on duty has received a summary of their call.
Value for the consumer is maximized through this
commerce function as well – our patient can reach a physician
literally ‘on call’ who guides her offline back to the brick and
mortar hospital environment using information gained online.
With Health 4.0, consumers are able to ‘dip’ in and out of
online and offline healthcare/wellness management systems
(hospitals, clinics) and services (communities, search) at will.
Again, the reason we have not yet arrived at the Health 4.0
stage is because the system lacks cohesive goods/services that
connect the first 3Cs: content, community, and commerce.
Innovation and continuity among multiple stakeholder groups,
not just patients and providers, are needed to prevent disparate
strategy development and episodic access and usage.
At this moment we cannot identify any true examples of
Health 4.0 companies. Even companies such as American
Well cannot yet send a transcript of the patient/physician chat
back to a local emergency room doctor in real-time, as we
illustrated in the example above. The service is ‘stuck’ in
Health 3.0 stage because it does not provide coherence that
ties the virtual interaction seamlessly back into multiple care
delivery nodes within the brick-and-mortar system.
IV. CURRENT EVOLUTIONARY STAGE: DEFINING HEALTH 2.0
IN DEPTH (CONTENT + COMMUNITY)
It is no coincidence that this paper terms evolutionary stages
of consumer-centric care ‘the 4Cs’ – the authors import
inspiration for this lexicon from original web pioneers,
including Tim Berners-Lee [6]. The Cs present in Health 1.0
and 2.0 detailed above, content + community, are also often
used to describe the evolution of Web 1.0 to Web 2.0.
Searching and reading information (content) was a key
function of the first generation internet – Web 1.0, also
sometimes called the “read-only” web. Control was in the
hands of a few publishers, who unilaterally determined what
information had value.
With Health 2.0, content + community, we witness a new
source of online authority – patient publishers entering the
space via blogs and other communities. Patients start to
express themselves and take an active role in the healthcare
process, beginning to ‘own’ care definitions. Patients begin to
communicate increasingly proprietary views on disease and
wellness management and its impact on personal identity.
With this new self-awareness comes curiosity about others -
patients begin asking questions (forums), establishing
relationships in online communities (social networks) and
collaborate to create authoritative, participatory content
(wikis). The 2008 Edelman Trust Barometer shows people
tend to trust “a person like me” more than authority figures
from business, government, and media” [7].
Although there is a great deal of debate about how precisely
to define Health 2.0, the subsector can also be described as
“the use of social software and its ability to promote
collaborations between patients, their caregivers, medical
professionals, and other stakeholders in health” [1]. An
example of patients trusting patients is TuDiabetes.com: “a
community for people touched by diabetes.” It currently
connects more than 2700 diabetics sharing experiences and
advice about their diseases through forums, chat, photos and
video.
Via sites like TuDiabetes.com, viewpoints such as “my
condition informs who I am, but does not equal my total
identity” and “I am a person who is also a patient, not a patient
who is also a person” ricochet around the web, and self-
advocacy begins to migrate offline.
Although Health 2.0 is positively advancing patient self-
advocacy, empowering us through new channels, the current
movement is still largely focused on the virtual, or ‘e-patient’
experience.
Another weakness of current Health 2.0 initiatives is the
tendency of communities to attract similar people. Many focus
on connecting “like-minds,” relatively homogeneous groups
such as patients with the same diagnosis or physicians in the
same subspecialty. Similar groups then generate very similar
content. Users become settled and ‘comfortable’ and thus less
inclined to venture out and advocate for other consumer
groups and systemic change.
Although people will always build communities that allow
us to establish a sense of belonging (“like attracts like”), the
semantic web can help solve this issue by enabling seamless
communications, thus making it ‘easy’ to establish relatively
‘pain free’ online and offline connections between many
different stakeholder groups (as illustrated in our respiratory
patient example above).
The current issue of online/virtual services often being
disconnected from real brick and mortar systems cannot be
addressed by technology alone. As a result, within the Health
2.0 community we already see evidence of an emerging need
for adding true value by making the service commercially
interesting (commerce) and a nebulous desire to connect
virtual services and brick and mortar systems (coherence).
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What we have been lacking, until now, is a practical,
relatively easy-to-follow model describing how to connect the
dots on the roadmap to consumer care.
V. SPARKING HEALTH 2.0 CHANGE: THE SEMANTIC WEB
The power of the semantic web is its ability to join many
different entities – it merges the ability to connect minds with
machines. This is precisely what is needed to break down silos
caused by disparate data ownership (and resulting authority
positions) in the current hierarchical system of care delivery.
To succeed in connecting myriad data points of
health/wellness/injury/illness data along a consumer’s lifeline,
a superhuman amount of computational capability is needed.
Minds or machines working separately cannot accomplish
the data sifting, prioritizing, and storing capabilities needed to
achieve Health 4.0 (4Cs): content + community + commerce
+ coherence = fully realized consumer centric care.
But minds and machines working in concert can. The
semantic web and concurrent open source API movement
harnesses the cognitive surplus of human and machine
computational power - using machines to help us get more
value for ‘mind time.’
Smart search is thus becoming the holy grail of Health 2.0
growth – how to harness user-centricity in disjointed systems,
connect communities with content, and build coherent
platforms that recombine brick and mortar “real world”
existing systems with virtual online software-as-a-service
(SaaS) offerings.
The semantic web is the holy grail of the Web dot-o
developmental crusade, just as fully realized consumer centric
care is Valhalla for Health 2.0 proponents.
VI. NEXTHEALTH: A CONCRETE MODEL FOR ORGANIZATIONS
JOURNEYING TOWARDS CONSUMER-CENTRIC CARE
Consumer-centric care is at the intersection of two
important developments: (1) joining patients and providers in
a collaborative conversation and (2) combining brick-and-
mortar systems with virtual services to allow seamless
interoperability.
Again, the arrival of Health 4.0 heralds fully realized
consumer-centric care, when consumers are able to selectively
‘dip’ in and out of online and offline systems and services at
will.
The ultimate goal of consumer-centric care on the clinical
side is to maximize efficient, empathic care. The ultimate goal
of consumer-centric care on the customer side is to encourage
‘staying well’ and the achievement of personal wellness goals.
A consumer-centric system relies on consumers sharing
responsibility. When consumers choose to assume
responsibility in the neXthealth model, they move towards
becoming proactive partners in care.
Full realization of Health 4.0 absolutely requires active
consumer engagement – not 100% engagement, which is
impossible to achieve, but consumer engagement according to
the 10-80-10 rule, where 10 percent of consumers will choose
not to engage the healthcare system, 10 percent will be ‘hyper-
Fig. 1 neXthealth: defining consumer-centric care at the intersection of (1)
joining patient and professional in the healthcare conversation and (2) using
brick-and-mortar systems and virtual services.
engaged super-patients,’ and most consumers will fall in the
middle 80 percent, choosing to become engaged some of the
time and to remain disengaged at other intersections of care
planning and delivery.
“At will” engagement means consumers select when and
where they wish to be engaged. Just as a patient today can
choose to refuse a medication or not follow doctors’ orders, a
consumer in the Health 4.0 era can refuse to engage with
semantic web advances, or can choose to adopt the latest HIT
or software-as-a-service (SaaS) offerings.
The central point is access at will, according to the
consumers’ wants – in Health 4.0 consumer access is not
limited according to an externally-dictated classification of
‘needs’ that results in the narrowing of access channels we see
in the current care delivery system.
It is also important to note consumer responsibility, as
detailed at the center of the neXthealth model (see Figure 1),
relies on transparency, which is certainly missing in the
current brick-and-mortar system.
Consumer-centric healthcare, Health 4.0, necessitates
consumers having shared access to data and thus and a shared
role in decision making. The realization of consumer-centric
care also relies on valuation made possible by minds and
machines working together, which is what the semantic web
provides.
Developments in semantic web technology are organized
and built out/developed according to value for the end user –
the consumer. It’s harnessing algorithms to meet the end-goals
of the user-base, as defined by developers.
In the next section of this paper, and during the concurrent
presentation at SWWS ’08, the authors will use their
neXthealth model to modelically illustrate how to plot both
current service lines and conceptual development initiatives
along the evolutionary stages moving us towards consumer-
centric care.
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Modelic illustration of how to, literally and figuratively,
connect the dots on the road to realizing Health 4.0 is vital
because the sector faces significant challenges related to the
divide between current brick-and-mortar systems and online
services. Some of the challenges are detailed below.
VII. CONSIDERATIONS FOR NEXTHEALTH
Although the authors optimistically map out a future where
consumers access web and real-world services that are
seamlessly integrated, the current reality is quite different.
Few doctors are even willing to answer e-mail. [8] Refusal
to integrate relatively ‘basic’ tech adoption into current
medical practice, such as using email and implementing
electronic health record systems (EHRs), demonstrates that
moving current healthcare providers (delivery) to more
extensive reliance on Web 2.0, HIT, Health 3.0, and other
internet-related services will be excruciatingly difficult.
Part of this reluctance results from financial systems that
don’t yet incentivize or pay doctors and other caregivers for
early adoption of new services to communicate and
collaborate with patients and other stakeholders [9]. Health
2.0 and 3.0 firms such as American Well are just starting to
change this [10].
In order to advance to Health 4.0, we need killer apps [11]
that promote access by decreasing complexity inherent in the
backend combination of multiple web-based technologies. A
killer app for consumer-centric care must be easy to use,
presented in a web-based format that is familiar to ‘basic’
internet users (email, online banking, auctions, chat room use,
photo upload/hosting, etc.) safe, and provided by a trusted
entity which takes consumers’ security concerns and providers
cost and portability concerns seriously.
Health 2.0 proponents must also be careful not to make the
same mistake as some developers working on the semantic
web: we must remain focused on the need for practicality.
What will consumer-centric killer apps be used for? By whom
will they be used?
We must not become so enthralled with multi-functionality
and elegant design that we ignore the value contributed by
simplistic, easy to use features – remembering always that
better care is the 5th C realized via consumer-centric health.
The moment multiple stakeholder categories can clearly see
the added value of Health 2.0 initiatives (and beyond), they
will start adjusting patterns of usage and behavior. Slowly at
first, but remember the goal is to first engage the 10% of the
population composed of ‘super patients,’ and then work on
building market-share among the middle 80%, the ‘sometimes
engaged.’
Although new to healthcare, driving behavior change by
marketing to consumers is certainly not new to other
customer-driven sectors such as online banking, online travel,
media, communications, and entertainment – an example is a
technological innovation like the iPhone. While mobile
internet technology has existed for quite some time, Apple’s
focus on ease of use and overall attractiveness of the offering
pulled customers over the line from polite interest to purchase
at point-of-sale. We must do the same in healthcare – provide
products and services that pull consumers from polite interest
to purchase.
At some point it really is all about ROI; value as return on
investment for the business entity and value as return on
individual goal realization for the healthcare consumer.
New dynamics enabled by the semantic web will enable a
brave 10% of super-patients to take the plunge and connect
with other than ‘standard’ stakeholders. Health 2.0 companies
must ensure they market aggressively to this segment, which
will become early evangelizers, embodying disruptive
innovation within the current system. During our presentation,
the authors will illustrate several real-world examples of how
to do this using the neXthealth model.
The authors will then literally connect the dots, moving
beyond Health 2.0 towards Health 4.0, by plotting service line
points. This visual representation makes it easy for audience
members to see how patients can connect with payers,
physicians with family, and many other forms of
communication that cause inefficiences.
Looking at the horizontal axis of Figure 1, this means that
patients and other stakeholders will have to expand beyond
what they view as their current network to deliver true
consumer-centric care.
The battle over control of information will be another
important issue that has to be addressed on the road to Health
4.0, as we will demonstrate using neXthealth. Hospitals
currently control much of the patient information, however
‘ownership’ of medical records and personal health
information is a hotly debated issue that will continue to
gather coverage [12]. Using a far more detailed model than the
basic neXthealth model above, the authors will illustrate why
co-creation and co-ownership is the only solution capable of
driving the consumer-health movement.
Co-ownership of records and cooperation with determining
personal wellness goals and resultant care pathways along a
consumer’s lifeline also necessitates a sea change in the
current relationship between patients and providers. We must
move from the current ‘dictation’ model to a ‘conversation’
where the input of both parties is valued.
This paradigm shift also asks the patient to trust service
providers with very intimate details of their lives, including
deeply personal wellness goals, which is more likely to
happen if the movement towards consumer-centric health is
well documented and gradual rather than highly reactionary
and sporadically defined. It is this desire to have all
stakeholders working from a commonly accepted, practical
model that inspired the authors to complete this paper. The
authors, in addition to other authorizes, realize that to change
the views of patient-provider interaction and encourage the
sharing of such intimate details, we must first bring personal
health application (PHAs) to full fruition via the semantic
web, where consumers are already used to sharing very
intimate details of our lives [13].
The final important barrier standing in the way of full
Health 4.0 realization is the joining of real brick and mortar
services with virtual online services. Different developments
and stakeholder groups in healthcare do not ‘play well’
together – it’s not a team sport yet.
Health 2.0 initiatives are currently relatively small startups
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filling specialized niches. But in healthcare filling niches is of
little use if complete industry steering remains solely in the
hands of massive, slow-moving conglomerates such as multi-
hospital systems.
This means that the true value of Health 2.0 and beyond
only exists as part of a larger, interconnected whole, as the
authors demonstrate using an expanded model based on Figure
1. This neXthealth model gives stakeholders concrete tools
needed to define their position (using existing service lines
and development initiatives) and focus on four critical factors
needed to realize true consumer-centric care: content,
community, commerce and coherence.
ACKNOWLEDGEMENTS
This research would not have been possible without the
generous help, inspiration and research support of those
involved with the first Health 2.0 Unconference NL (April 12,
2008). Special thanks go to those involved in realizing the
neXthealth initiative with verve, passion, and speed: Martijn
Hulst, Jacqueline Fackeldey, Jeroen Kuipers and Niels
Schuddeboom. The authors extend a special vote of gratitude
to Dr. Lodewijk Bos for providing a link to the conference and
his comments on this paper.
APPENDIX
Different factors drive the evolution of Health 2.0 towards
true consumer-centric care (neXthealth). For the purposes of
this presentation, providing a practical roadmap to consumer
centric care, the authors didn’t wish to focus extensively on
barriers to entry or contributing factors. However, the authors
have identified five important trends which they will detail in
future publications. For SWWS ’08 attendees interested in the
evolution of Health 2.0, however, we provide some
publications and suggestions for further reading.
Five primary trends include (1) increasing costs and
competition (2) increasing complexity (3) changing control
responsibility, (4) focus on personalization, (5) continuous
innovation.
(1) Increasing costs and competition. Healthcare costs for
the individual are increasing [14] and current spend levels of
healthcare in many countries are unsustainable. Total costs of
the American healthcare system are currently 2.2 trillion
dollars. This clearly signals the need for systems and services
enabling less costs and better outcomes [15]. Incentives should
be more focused on quality and less on quantity [9]. Health
2.0 tends to fill a portion of this gap by delivering high value
(highly patient-oriented care options) at relatively low cost.
(2) Increasing complexity. The global amount of data is
exponentially expanding and rapidly dispersing at the same
time, signifying the need for improved communication,
visualization, and prioritization of information. Data is spread
between hospital EHRs, pharmacy databases, and GP systems
etcetera. Complexity is further increased by global
collaboration [2]; medical robotics [16] personalized medicine
(genomics), disparities in access in the developing/developed
countries, and the ‘explosion’ of healthcare IT in general. Not
only do these developments stress the need for communication
and visualization (‘being in control’), but also the need for
navigators – both people and services that coordinate care and
guide users through the complex delivery system. There is
great potential for semantic web initiatives to combine minds
and machines to address this need.
(3) Changing control responsibilities. Consumers are
increasingly becoming engaged and taking responsibility for
their own healthcare decision making [14]. This increases the
need for systems and services that help manage conditions
[17] as well as track, share and reach life and wellness goals.
While some of these initiatives stir extremely contentious
debates related to privacy and access concerns (e.g. the
discussion of PatientsLikeMe members sharing information
about drug use), at the same time ultimately consumer-centric
applications address those concerns by giving control to the
patient (PHR) instead of the system (EHR). This clash of the
‘data titans’ is will be an important driver for the adoption and
development Health 2.0 (and neXthealth) initiatives.
(4) Focus on personalization. Personalization in healthcare
is not only apparent in the shifting of costs and coordination
responsibilities, but also in other innovations such as
personalized medicine (genomics) and changing business
models (retail medicine). These developments propel the
evolution of Health 2.0 by providing the healthcare consumer
with new personalized tools. Examples are new genetic
screening services (23andme) consumer-oriented PHR
providers (HealthVault, Google Health) and retail clinics
(Wal-Mart, MinuteClinic).
(5) Continuous, concurrent innovation. Innovation in
healthcare is happening in many areas, all at once: medicine
and treatments, IT/technology, processes etcetera. These
innovations are continuous rather than sporadic [18]. While
one could argue a myriad of smaller innovations are less likely
to have widespread disruptive effects similar to the invention
of penicillin or anesthetics or discovering the polio vaccine,
we must be cautious not to underestimate the combined
valuation of many smaller scale innovations and inventions
now focusing on the consumer (cf. the Long Tail [19]). This
increasing focus on the consumer is visible in current practices
of evidence based medicine and evidence based design [20].
REFERENCES
[1] Jane Saraohn-Kahn, The Wisdom of Patients: Health Care Meets Online
Social Media, California HealthCare Foundation, 2008;
http://www.chcf.org/documents/chronicdisease/HealthCareSocialMedia.
pdf.
[2] E-Health Media, “E-Health Europe :: Call for semantic health
interoperability”;
http://www.ehealtheurope.net/news/3725/call_for_semantic_health_inter
operability.
[3] Newsweek, “My Healing Diabetes Blog,” Newsweek.com, Jan. 2008;
http://www.newsweek.com/id/104413.
[4] Maarten den Braber, “Building value based hospital strategy.” (not
published)
[5] Wireless Health Care “Telemedicine Mobilised With Cell Phone,” May.
2008; http://www.wirelesshealthcare.co.uk/wh/news/wk20-08-0001.htm.
[6] Charles Cooper, “Why it's time to dump the Web 2.0 sobriquet once
and for all,” Apr. 2008; http://www.news.com/8301-10787_3-9929415-
60.html.
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[7] Edelman, “2008 Trust Barometer”;

http://www.edelman.com/trust/2008/.
[8] The Associated Press, “Few doctors answer patient e-mails with a :),”
USA Today, Apr. 2008.
[9] WBUR, The Doctor Can't See You Now, 2008;
http://www.insideout.org/documentaries/primarycare/.
[10] American Well, “American Well - The Next Generation of Health
Communication”; http://www.americanwell.com/.
[11] Vijay Goel, “Consumer engagement and the PHR: Still awaiting the
killer app: a hosted discussion on innovation in health care,” World
Health Care Blog, Apr. 2008;
http://www.worldhealthcareblog.org/2008/04/22/consumer-engagement-
and-the-phr-still-awaiting-the-killer-app/.
[12] Jacob Goldstein, “How Personal Health Records Could Make Care Less
Efficient,” The Wall Street Journal Health Blog, Apr. 2008;
http://blogs.wsj.com/health/2008/04/25/how-personal-health-records-
could-make-care-less-efficient/?mod=WSJBlog.
[13] Robert Steinbrook, “Personally Controlled Online Health Data -- The
Next Big Thing in Medical Care?,” N Engl J Med, vol. 358, Apr. 2008,
pp. 1653-1656.
[14] “Informed Medical Decisions - Information To Make Sound Medical
Decisions”; http://www.informedmedicaldecisions.org/.
[15] Michael Porter and Elisabeth Teisberg, Redefining Health Care:
Creating Value-based Competition on Results, Harvard Business School
Press, 2006.
[16] “Intuitive Surgical, Inc”; http://www.intuitivesurgical.com/index.aspx.
[17] “SugarStats.com - Simple, Online Blood Sugar Tracking for Diabetes
Management”; http://www.sugarstats.com/.
[18] Ted Eytan, “The Patient is Still the Focus: 21st Century Family
Medicine in Sebastopol, California,” May. 2008;
http://www.tedeytan.com/2008/05/03/904.
[19] Chris Anderson, The Long Tail: Why the Future of Business is Selling
Less of More, Harper Collins USA, 2006.
[20] The Center for Health Desgin, “Definition of Evidence-Based Design
for Healthcare”;
http://www.healthdesign.org/aboutus/mission/EBD_definition.php.

Jen McCabe Gorman is a blogger and consultant covering global hospital

innovation and the consumer-centric healthcare movement at Health
Management Rx (www.healthmgmtrx.blogspot.com). She sources news and
interviews for The Health Care Blog and Health 2.0 USA. Admitted to
Georgetown University’s Master of Health Systems Administration Program,
she will matriculate in 2009.
Current research (to be presented at Medicine 2.0 2008) includes the role
of medical blogging in eliminating the patient ‘other,’ defining the evolution
of Health 2.0, 3.0, 4.0 and harnessing the semantic web to spark systemic
change.
As a consultant with a research/analysis background, she remains involved
in vetting health information technology startups. For Health 2.0 USA
(Matthew Holt & Indu Subaiya), Jen created a custom methodology to
evaluate quantitative and qualitative factors of Health 2.0 companies.
An accomplished patient advocate, Jen serves as Vice Chair, Board of
Directors, for Baltimore-based nonprofit MEDBANK of Maryland, Inc.
(www.medbankmd.org), which provides free prescription medications to
35,000 residents via pharmaceutical firms' patient assistance programs
(PAPs). She is a current Washington Metro Society of Healthcare Marketing
& PR member and a member of the American College of Healthcare
Executives (ACHE).
Maarten den Braber is a master student Industrial Engineering and
Management at the University of Twente, specializing in Healthcare
Technology and Management. He is currently (School of Management and
Governance) finishing his master thesis on Building Value-Based Hospital
Strategies at the Dutch Institute of Knowledge-Intensive Entrepreneurship.
Interested in the combination of healthcare, events and technology,
Maarten is focused on developing new disruptive business models in
healthcare leveraging the power of the network to find new ways to engage
patients.